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Related Experiment Videos

How much is postacute care use affected by its availability?

Melinda Beeuwkes Buntin1, Anita Datar Garten, Susan Paddock

  • 1RAND Health, 1200 South Hayes St., Arlington, VA 22202, USA.

Health Services Research
|March 15, 2005
PubMed
Summary

Post-acute care (PAC) supply, not just patient condition, heavily influences choices between skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs). Facility availability and proximity are key determinants of PAC utilization for elderly patients.

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Area of Science:

  • Health Services Research
  • Geriatric Medicine
  • Healthcare Policy

Background:

  • Understanding determinants of post-acute care (PAC) utilization is crucial for optimizing patient transitions after acute hospitalization.
  • Previous research has focused on clinical factors, but the role of nonclinical factors like PAC supply needs further investigation.

Purpose of the Study:

  • To compare the influence of clinical factors versus nonclinical factors, specifically PAC supply, on the choice of skilled nursing facilities (SNFs) or inpatient rehabilitation facilities (IRFs).
  • To analyze predictors of PAC site selection for elderly patients following hospitalizations for stroke, hip fractures, or lower extremity joint replacements.

Main Methods:

  • Utilized Medicare claims data for acute hospital, IRF, and SNF utilization.

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  • Incorporated data from Medicare enrollment files and the Area Resource File to identify predictors of PAC choice.
  • Employed multinomial logit models to predict PAC use in elderly patients.

    • Main Results:

    • Post-acute care (PAC) availability emerged as a stronger predictor of PAC use than clinical characteristics in many models.
    • Proximity and supply of inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) significantly influenced patient site selection.
    • Patients were more likely to be discharged to a PAC facility affiliated with their discharging hospital.

    Conclusions:

    • The availability and type of post-acute care (PAC) facilities are major determinants of PAC utilization and site choice.
    • Further research is warranted to determine if increased PAC supply leads to better outcomes or unwarranted expenditures and delayed recovery.